<div class="register-title">
  <h4 class="title">Or Create</h4>
  <div id="registerbox" class="registerbox">
    <form action="" method="post" name="register" id="register-form">
      <fieldset class="input">
        <p id="register-form-firstname">
          <label for="modrgs_firstname">Firstname</label> <input id="modrgs_firstname" type="text"
            name="modrgs_firstname" class="inputbox" size="18" autocomplete="off">
        </p>
        <p id="register-form-lastname">
          <label for="modrgs_lastname">Lastname</label> <input id="modrgs_lastname" type="text"
            name="modrgs_lastname" class="inputbox" size="18" autocomplete="off">
        </p>
        <p id="register-form-username">
          <label for="modrgs_username">Username</label> <input id="modrgs_username" type="text"
            name="modrgs_username" class="inputbox" size="18" autocomplete="off">
        </p>
        <p id="register-form-password">
          <label for="modrgs_passwd">Password</label> <input id="modrgs_passwd" type="password"
            name="modrgs_passwd" class="inputbox" size="18" autocomplete="off">
        </p>
        <p id="register-form-repeat-password">
          <label for="modrgs_rppasswd">Repeat Password</label> <input id="modrgs_rppasswd"
            type="password" name="repeat-password" class="inputbox" size="18" autocomplete="off">
        </p>
        <p id="register-form-email">
          <label for="modrgs_email">Email</label> <input id="modrgs_email" type="password"
            name="modrgs_email" class="inputbox" size="18" autocomplete="off">
        </p>
        <br /> <input type="submit" name="Submit" class="button" value="Register">
      </fieldset>
    </form>
  </div>
</div>